Self referral form

Referral for Adult Services (18+)

BSARCS has a range of support services available. If you would like to know more please use the form below and we will be in touch.

* Denotes a required field

Type of service required *

Can we text this number? *

Can we leave a voicemail on this number? *

Can we write to you? *

Can we write to you on headed paper? *

Once you have submitted this form we will add you to our system and one of our team will be in touch soon.

RCEW Helpline 0808 802 9999 (women and girls)
Safeline 0808 800 5005 (men)
Samaritans 116 123

In an Emergency call 999